目的分析研究长疗程服用米非司酮对子宫肌瘤患者糖皮质激素的影响及缩瘤效果。方法 90例子宫肌瘤患者从月经1~2 d开始服用米非司酮,连续服用6个月,分别在治疗前、治疗3个月、治疗6个月时测量患者子宫和肌瘤的三维径线,同时用免疫化学发光法测定患者的血清皮质醇、雌二醇、孕酮、促黄体生成素、促卵泡素,在治疗过程中观察患者是否出现不良发应。结果患者服药3个月后,促黄体生成素有显著升高,服药6个月后升高幅度有所减低,治疗前与治疗3、6个月后对比差异具有统计学意义(P<0.05),治疗6个月后明显低于治疗3个月后(P<0.05);孕酮和皮质醇均先升高再下降,治疗6个月后孕酮和皮质醇水平均低于治疗前及治疗3个月后(P<0.05);治疗前后患者雌二醇及促卵泡素水平对比差异无统计学意义(P>0.05)。治疗3个月后,子宫和肌瘤的最大体积均较治疗前显著缩小(P<0.05),肌瘤体积缩小43.8%,子宫体积缩小27.6%;治疗6个月后,子宫和肌瘤的最大体积继续缩小,肌瘤体积缩小57.7%,子宫体积缩小42.7%,与治疗3个月比较差异具有统计学意义(P<0.05)。治疗3个月后,40例患者出现糖皮质激素症状,当患者使用米非司酮6个月后上述症状依然存在,但无明显加重迹象。40例出现糖皮质激素症状患者的血清皮质醇治疗3个月后较治疗前明显升高,治疗6个月较治疗前明显降低(P<0.05)。患者经过治疗后临床症状均显著的改善,患者在用药期间均出现闭经情况,在停药4周后月经恢复。结论长疗程服用米非司酮可以有效缩小子宫肌瘤;部分患者出现抗糖皮质激素效应,这种效应还会随着血清皮质醇而波动,判断是否有米非司酮抗糖皮质激素效应的发生不适合用测定血清皮质醇水平的方法。 Objective To study the effect of mifepristone on glucocorticoid in patients with uterine fibroids and the effect of tumor shrinkage on long course of treatment. Methods Ninety patients with uterine fibroids were treated with mifepristone from 1 to 2 days after menstruation for 6 months. The three-dimensional diameter of the uterus and fibroids were measured before treatment, 3 months and 6 months respectively. At the same time, the levels of serum cortisol, estradiol, progesterone, luteinizing hormone and follicle stimulating hormone were measured by immunochemiluminescence, and the patients were observed for adverse reactions during the course of treatment. Results After 3 months of treatment, the luteinizing hormone of patients was significantly increased. After six months of treatment, the increase rate of luteinizing hormone decreased slightly. There was significant difference between before treatment and 3 and 6 months after treatment (P <0.05) , 6 months after treatment was significantly lower than 3 months after treatment (P <0.05); progesterone and cortisol both increased and then decreased after 6 months of treatment progesterone and cortisol levels were lower than before treatment and treatment After 3 months (P <0.05), there was no significant difference in estradiol and follicle stimulating hormone before and after treatment (P> 0.05). After 3 months of treatment, the maximum volume of uterus and fibroids was significantly reduced (P <0.05), the volume of fibroids was reduced by 43.8% and the volume of uterus was reduced by 27.6%. After 6 months of treatment, the maximum of uterus and fibroids Volume continued to shrink, fibroids reduced 57.7%, uterine volume reduced 42.7%, compared with 3 months of treatment was statistically significant difference (P <0.05). After 3 months of treatment, glucocorticoid symptoms were observed in 40 patients and the symptoms persisted after 6 months of treatment with mifepristone, but no signs of worsening were observed. Serum cortisol in 40 patients with symptoms of glucocorticoids was significantly increased 3 months after treatment, 6 months after treatment was significantly lower than before treatment (P <0.05). After treatment, the clinical symptoms of patients were significantly improved. All patients underwent amenorrhea during menstruation. Menstruation was resumed after 4 weeks’ withdrawal. Conclusion Long course of taking mifepristone can effectively reduce uterine fibroids; some patients appear anti-glucocorticoid effect, this effect will fluctuate with the serum cortisol, to determine whether mifepristone anti-glucocorticoid effect A method that is not suitable for determining serum cortisol levels occurs.